Repeated group alternation as a programming strategy for essential tremor patients experiencing rapid habituation with deep brain stimulation treatment

The term habituation refers to the rapid loss of therapeutic effects that occurs following an initially beneficial adjustment of Deep Brain Stimulation (DBS) parameters. DBS habituation typically occurs over a period of days to weeks and has been observed in a subgroup of essential tremor (ET) patients undergoing stimulation of the ventral intermediate nucleus of the thalamus (VIM). The negative consequences of DBS habituation include protracted periods of ineffective therapy, the exacerbation of symptoms beyond presurgical levels (rebound), and the requirement for repeated office visits for stimulation adjustments. In this case series, we describe a programming strategy implemented in three patients with ET experiencing DBS habituation. This strategy involves the planned alternation between pre-programmed electrode configurations (‘groups’), performed by the patient prior to or in response to the loss of therapeutic efficacy in habituation. <b>Results/Conclusions:</b> We provide here additional support for group alternation as a treatment option for DBS patients with ET complicated by tremor habituation.